Respiratory Therapy Application

I am applying for admission in the following semester.

Personal References

The Kansas Board of Healing Arts, and other professional licensing offices of other states, will do a criminal background check before granting a student permit or therapist license. A criminal record may place restrictions on the permit/license, or may be cause for denial of a permit/license. Clinical facilities affiliated with the program require background checks. The Respiratory Therapy Program will also conduct a criminal background check. Results may affect your ability to access clinical settings.

The Respiratory Therapy Program is collaboratively offered in affiliation with several clinical facilities including but not limited to Centerpoint Medical Center (Independence, MO), Kindred Hospital (Kansas City, MO), Liberty Hospital (Liberty, MO), North Kansas City Hospital (North Kansas City, MO), Providence Medical Center (Kansas City, KS), and The University of Kansas Hospital (Kansas
City, KS). Each clinical affiliate determines if and when students may use their facility. Clinical affiliations are subject to change.

Please note that the clinical facilities affiliated with the program may require drug testing at any time. Use of illicit drugs will result in release from the program. Further, students are expected to comply with clinical policies of the program and the affiliates. Noncompliance with policies of the program or of a clinical affiliate will result in release from the program.

Please note that there is substantial pre-requisite/co-requisite coursework that must be completed prior to graduating from the Respiratory Therapy Program. Respiratory Therapy courses need to be taken in an approved program sequence. Students must achieve passing scores on program exit to graduate.

Please note that applicants to the Respiratory Therapy Program need to submit the following. Early applications are preferred.

Applications are, however, accepted through the week prior to the commencement of classes.

1. Kansas City Kansas Community College Application, if not currently enrolled
2. This program application
3. Official college transcripts

Kansas City Kansas Community College is an equal opportunity educational institution.

I hereby certify that the foregoing statements, made by me, are true and correct to the best of my knowledge. I authorize KCKCC and/or the Respiratory Therapy Program and/or any or all clinical affiliates to investigate all statements made in this application.

Such investigation may continue up to but not longer than the period of my enrollment in the program, if accepted. I agree that KCKCC, the Respiratory Therapy Program, clinical affiliates, nor my references shall in any way be liable to me because of any information given to KCKCC, the Respiratory Therapy Program or clinical affiliates. If this application is rejected as a result of inquiries made, KCKCC, the Respiratory Therapy Program, or the clinical affiliates shall have no obligation to advise me of the reason for the rejection. Falsification of any information listed in this application will be sufficient cause for expulsion.